Introduction

Prison officials and staff across the United States are confronting a growing crisis in inmate healthcare. Under the law (and Supreme Court precedent), correctional systems are constitutionally required to provide adequate medical, mental, and dental care to incarcerated people. In practice, however, facilities nationwide are struggling to meet even basic health needs. From chronic physical illnesses and infectious diseases to rampant mental health issues, the incarcerated population is older and sicker than ever before. Resources have not kept pace with this need, leading to inadequate treatment, long delays, and sometimes tragic outcomes. As one expert starkly observed, “Health care behind bars is bad even in the best scenarios… Prisons are not places that are therapeutic or designed to heal; they are places that are designed to punish.” This strictly informative overview examines the major challenges in inmate healthcare today – including physical health, mental health, dental care, access to medications, staffing shortfalls, and treatment delays – and how these issues are creating serious challenges for prison operations and staff nationwide.

Physical Health Challenges in an Aging Prison Population

America’s prison population is rapidly graying, bringing a host of chronic health problems. The share of incarcerated people aged 55 or older has quintupled over the past few decades – from only about 3% of prisoners in 1991 to roughly 15% by 2021 – and that number continues to rise. In fact, the total number of older individuals behind bars grew from 166,000 in 2020 to 186,000 in 2022. Medical experts note that a 59-year-old in prison has the same morbidity rate as a 75-year-old in the community, due to the harsh conditions and inadequate care accelerating health decline. Not surprisingly, over half of incarcerated people have at least one chronic medical condition such as hypertension, diabetes, or asthma. These ailments require ongoing management – yet prisons are ill-equipped to provide consistent, quality treatment. Studies show chronic conditions are even more common in prison today than in the early 2000s, with 62% of inmates in 2016 reporting at least one chronic illness (up from 56% in 2004).

Compounding the challenge, prisons house disproportionately high rates of infectious disease. A 2024 review in The Lancet found that about 18% of incarcerated adults tested positive for hepatitis C antibodies, far higher than the general public, and significant percentages had been infected with tuberculosis, hepatitis B, or HIV. Communicable illnesses spread easily in crowded facilities – a fact made brutally clear during the COVID-19 pandemic. In 2020, deaths among incarcerated people jumped by almost 50% compared to the prior year, with older prisoners experiencing the most drastic surge in mortality. Many so-called “natural” deaths in custody were later revealed to stem from untreated or poorly managed medical conditions. For example, a 67-year-old Arizona inmate named Walter Jordan died in “excruciating needless pain” from a cancer that would likely have been survivable with timely care. His case, sadly, is not unique – numerous court investigations have found that delayed or inadequate treatment has led to preventable deaths behind bars.

Prison medical systems are straining under these trends. State correctional healthcare spending has soared (often exceeding budgeted amounts year after year) as facilities try to keep up with the aging, ailing population. In North Carolina, for example, the prison system spent $429 million on inmate health care in FY2023-24 – about a quarter of its entire corrections budget – after costs grew 36% in five years. Yet even increased spending has not translated to adequate care in many instances. Outbreaks of illnesses (from COVID-19 to seasonal influenza and drug-resistant tuberculosis) have overwhelmed prison infirmaries. Many facilities also lack specialty services on-site, meaning patients with cancer, heart disease, kidney failure and other serious conditions face long waits for outside appointments – if they get seen at all. In sum, the physical health needs of U.S. inmates are high and rising, but the capacity and quality of prison healthcare remain distressingly low. This imbalance leaves correctional staff managing an ever-sicker population with minimal support, and leaves incarcerated people themselves enduring poor health outcomes that would be unacceptable in any other setting.

Mental Health Crisis Behind Bars

Alongside physical ailments, U.S. prisons are grappling with a profound mental health crisis among inmates. By best estimates, around 2 in 5 incarcerated individuals have a history of mental illness – roughly 43% of people in state prisons (and 44% in local jails) have been diagnosed with at least one mental disorder. These include high rates of serious conditions such as major depression, bipolar disorder, post-traumatic stress, and schizophrenia. In fact, the prevalence of every major mental health condition in prisons increased dramatically between 2004 and 2016, and the share of inmates with chronic mental illness nearly doubled (from 14% to 27%) in that period. In short, U.S. prisons house a large population of individuals in dire need of psychiatric care, counseling, and support.

A mental health counselor meets with an incarcerated person at a prison in North Carolina. Many inmates have serious mental health needs, but treatment resources are often strained in correctional facilities. Despite the high need, mental health services behind bars are severely under-resourced. A majority of inmates who need treatment do not receive it. One analysis found that 66% of people in federal prisons reported not receiving any mental health care during their incarceration. Similarly, about one-third of state prisoners with a persistent mental illness had not received treatment since being admitted to prison. Prisons often lack sufficient psychiatrists, psychologists, and social workers on staff, leading to large caseloads and minimal therapy or monitoring. Many systems rely heavily on telehealth or brief visits by outside clinicians. For example, North Carolina holds regular tele-psychiatry clinics and has a limited number of inpatient psychiatric beds (just 154 for a state prison population over 30,000). Wait times to see a counselor or psychiatrist can stretch for weeks or months in some facilities.

The consequences of untreated mental illness in prison can be devastating. Incarcerated people with serious disorders may deteriorate in isolation, become victimized, or harm themselves or others when their symptoms go unchecked. Suicide is a persistent concern – especially in jails, but also in state prisons. In Georgia’s state prison system, for example, 38 incarcerated people died by suicide in fiscal year 2023, a spike that coincided with severe understaffing and deteriorating conditions. Corrections officers, who are not mental health professionals, often find themselves responding to mental health crises (such as suicide attempts, self-harm incidents, or psychotic episodes) without adequate training or support. This takes a toll on staff and can escalate into safety incidents. One formerly incarcerated woman from Georgia described how extreme understaffing and neglect of mental health led to “everyone’s mental stability” deteriorating, fueling depression and fights inside the prison.

Untreated mental illness in prison is also a public safety issue beyond the prison walls. Most incarcerated people will eventually be released, and if their mental health has worsened during confinement, their prospects for successful reentry dim. Unfortunately, many prisons today function as de facto psychiatric institutions without the resources or design to fulfill that role humanely. The ongoing mental health crisis behind bars creates daily challenges for correctional staff and poses ethical and legal dilemmas for prison administrators. Addressing it would require major investments in staffing (more clinicians, counselors, and psychiatric beds) and changes in approach – but until that happens, prisons will continue to struggle with rising numbers of inmates in psychological distress.

Neglected Dental Care and Oral Health

Often overlooked in discussions of prison healthcare is the stark reality of dental care (or the lack thereof) for inmates. Poor oral health is pervasive among incarcerated populations – many enter prison having had little access to regular dental care, and incarceration often makes the situation worse. In most U.S. prisons, routine preventative dentistry is virtually non-existent; the norm is to address dental issues only when they become acute emergencies.

An incarcerated patient receives dental treatment at San Quentin State Prison’s medical facility. In many prisons, dental intervention occurs only once issues become severe – often resulting in tooth extractions instead of restorative care. Former prisoners commonly report that minor dental problems are left to fester until they turn into extreme pain or infection. “Many prisons will wait till a tooth problem is an absolute emergency before they do something,” explained one reentry services provider. Even when inmates are suffering obvious dental crises – such as swollen faces from abscesses – they may endure lengthy waits for an appointment. Delayed treatment can mean a cavity that might have been filled early ends up requiring an extraction (or worse, spreads infection). In fact, extraction is the most frequent outcome for serious dental issues in prison. Dentists in correctional facilities often opt to pull diseased teeth rather than perform more complex (and time-consuming) procedures like root canals or crowns. Courts have generally deemed a simple extraction an “adequate” treatment, which creates a perverse incentive for prison dentists to choose the quickest fix. As a result, inmates who might have saved teeth in a community setting instead lose them in prison. Getting dentures or implants to replace lost teeth is exceedingly difficult under most prison policies – these are often labeled “cosmetic” procedures. For example, the Federal Bureau of Prisons will not provide dentures if an inmate still has a minimum number of opposing teeth (usually 8) that allow chewing, even if the person has large gaps elsewhere. Some state systems set the threshold at 6 teeth, meaning an individual could have almost no teeth on one side of their mouth and still not qualify for dentures. In practical terms, many incarcerated people end up toothless or with severe dental issues that make eating and speaking difficult, yet they have no way to get proper restorative treatment.

Extreme cases illustrate just how deficient prison dental care can be. In Missouri, one incarcerated man in severe dental pain actually pulled out his own teeth in 2021 after he was unable to secure any dental appointment for relief. His desperation underscores how basic oral healthcare is often out of reach in prisons – a reality that would shock most outsiders. Even relatively routine procedures like fillings can be hard to come by; prisoners frequently report that facilities simply offer ibuprofen for pain and postpone real treatment until they have no choice but to extract the tooth. Years of neglect take a cumulative toll: by the time people are released, they may have lost multiple teeth or developed gum disease and other complications. (One survey by the American Dental Association found that 29% of low-income adults – the demographic from which most inmates come – believe the state of their teeth affected their ability to interview for jobs. This illustrates how untreated dental problems can continue to harm formerly incarcerated individuals long after release, hindering their confidence and employment prospects.)

Why is prison dental care so poor? Part of the issue is staffing and funding: dentists are in short supply in many correctional systems, and historically these positions have been underpaid. In California, a lawsuit in the 2000s exposed grossly inadequate dental care in state prisons and was only resolved after the department raised dentist salaries and improved facilities. Nonetheless, even today certain services (like orthodontics or specialized oral surgery) are typically unavailable to inmates. Security protocols also play a role – moving prisoners to outside dental specialists is logistically difficult and often avoided unless absolutely necessary. The end result is a system where inmates’ oral health is managed through crisis response rather than preventive care. For correctional staff, this means dealing with frequent medical complaints and potentially avoidable emergencies (infected teeth can cause fevers, cardiac complications, etc., if not treated). For inmates, it means a great deal of needless pain and long-term health consequences that go unaddressed.

Barriers to Medications and Treatment Access

Obtaining appropriate medications in a prison setting can be fraught with obstacles. One major barrier is the prevalence of medical co-pays and fees charged to inmates. In most state prison systems, incarcerated people must pay a small fee (for instance $2 to $5) to see a doctor or obtain a prescription. On the surface this sounds minimal, but consider that prison jobs often pay pennies per hour – a $5 fee might equal a week or more of an inmate’s wages. These co-pays have been shown to deter prisoners from seeking care or medications, even when they have chronic health needs. A recent study found that in prisons charging higher fees (more than a week’s wage for one visit), people with chronic conditions were significantly less likely to have seen a healthcare provider during incarceration. Over 12% of prisoners with a chronic physical illness in high-copay states had never been seen by a clinician in over a year of imprisonment, compared to under 8% in states with no or low co-pays. In other words, thousands of incarcerated patients are forgoing necessary medical visits because they simply cannot afford them – a situation that inevitably leads to worse outcomes and costlier emergencies down the line. Some states do waive fees for certain services (like care for chronic illnesses or pregnancy), but even then, prisoners may have to pay for initial sick call visits before qualifying for a waiver. The bureaucracy of prison healthcare can be daunting: requesting a medication or medical device that isn’t pre-approved requires an onerous approval process, during which officials consider “facility security and cost” in addition to patient benefit. This means treatments that would be readily prescribed in the community might be denied or delayed in prison due to non-medical factors.

Another critical issue is access to medications for substance use disorders, especially amidst the opioid overdose epidemic. Evidence-based medications like methadone and buprenorphine (which treat opioid addiction) dramatically reduce overdose deaths and improve outcomes. Yet historically, U.S. jails and prisons have offered very limited medication-assisted treatment (MAT). There are recent improvements – some correctional systems have started MAT programs – but as of 2023 the gap remains large. A nationwide survey of over 1,000 county jails revealed that fewer than half (43.8%) offered any form of opioid use disorder medication to incarcerated people, and only about 12.8% of jails made these medications available to all individuals who needed them. This is despite the fact that roughly two-thirds of people in jails have a substance use disorder (in many cases opioid-related). The survey also pinpointed the main reason for not offering MAT: lack of adequate medical staff to administer and oversee the treatment, as cited by nearly 50% of jail administrators. Other barriers include cost and regulatory hurdles, but staffing was the most common issue. In prisons (which generally hold longer-term inmates), MAT has also been slow to expand, though states like Rhode Island and Massachusetts have pioneered offering these medications system-wide. Still, in federal prisons for instance, it was reported that only 1.5% of eligible individuals received MAT for opioid use disorder in 2022, underscoring how limited access remains in many facilities.

Medication access problems extend to other areas as well. In some prisons, essential chronic disease medications (for diabetes, hypertension, HIV, etc.) may be subject to strict formulary rules – meaning if an inmate’s existing prescription isn’t on the approved list, it can be discontinued or substituted upon intake. Gaps in care during intake or transfers can lead to missed doses. There have been lawsuits over failure to provide life-saving drugs: for example, North Carolina was sued in 2021 for not treating incarcerated patients with new curative Hepatitis C medications, leading the state to settle and start providing the expensive antivirals more broadly. Similarly, prisons often lag in offering newer treatments due to budget constraints; effective but costly drugs (for cancer, Hep C, autoimmune diseases, etc.) might be rationed or delayed until absolutely necessary.

Even upon release, continuity of medication can be an issue. Recognizing this, federal policy changes in 2023 now encourage states to ensure inmates have a 30-day supply of their prescriptions when they reenter society, to bridge the gap until they can see a community provider. But within prison walls, the bottom line is that getting the right medication at the right time is not always straightforward. Many incarcerated people encounter hurdles that patients in free society do not – whether that’s having to pay fees they cannot afford, facing delays for non-formulary drug approvals, or being denied certain therapies altogether. For correctional healthcare staff, these policies can be a double-edged sword: on one hand intended to control costs and security risks (e.g. preventing abuse of certain drugs), but on the other hand creating more work and ethical strain as they see patients go without beneficial treatment. For the inmates, these medication barriers can literally be life-threatening in cases of serious illness or addiction.

Staffing Shortages in Correctional Healthcare

Virtually every problem in prison healthcare is exacerbated by one overarching issue: severe staffing shortages. In the past few years, correctional systems across the country have seen an exodus of medical personnel and frontline officers, leaving critical positions unfilled. By 2023, the number of people working in state prisons (guards, nurses, doctors, and all) dropped to the lowest level seen this century. This staffing crisis affects all aspects of prison operations, but its impact on healthcare delivery is especially direct. Prisons cannot provide timely, quality care without nurses, physicians, dentists, and mental health professionals – yet many institutions struggle to recruit or retain such staff.

Healthcare vacancy rates in corrections are staggering in some states. For example, the North Carolina Department of Adult Correction reported in 2025 that 28% of its healthcare positions were vacant, including over one-third of nursing jobs unfilled. With more than a quarter of nurses and clinicians missing, the remaining medical staff are stretched paper-thin. The department has had to rely heavily on contract and traveling nurses to plug the gaps – now over half of the prison system’s nurses are temporary contractors rather than full-time staff. This stopgap measure ensures minimal coverage but comes at a high financial cost (contract nurses are paid a premium) and can lead to continuity-of-care issues. Meanwhile, security staff shortages indirectly hamstring healthcare: when there aren’t enough correctional officers to escort prisoners to the medical unit or outside appointments, those appointments get postponed or canceled. In some facilities, routine clinics have been scaled back simply because officers are unavailable to transport and supervise the patients. In one account, incarcerated women in Georgia said they endured “long waits for essential medical appointments” because chronic officer understaffing meant there was no one to take them to the infirmary or hospital.

Healthcare staffing shortfalls are apparent in high-profile prison lawsuits as well. In Arizona, a long-running lawsuit over prison healthcare (now Jensen v. Thornell) recently revealed that the state’s private contractor had over 100 healthcare staff vacancies unfilled. The shortage was so dire that nurses (with relatively limited training) were often tasked with duties that should be handled by physicians or specialists. Court experts reviewing Arizona’s prisons in 2023 noted “extreme delays” in care and a chronic failure to send patients to outside specialists, due in part to not having enough qualified staff to evaluate, refer, and follow up on complex cases. The contractor’s attempts to recruit more doctors were woefully insufficient – at one point, they offered only a “paltry” $2 per hour salary increase for physicians in an effort to attract candidates, which unsurprisingly had little effect. Low pay, remote prison locations, safety concerns, and high burnout all make hiring medical personnel for prisons a challenge. Even when new hires come in, turnover is high. Many clinicians last only a short time in the difficult prison environment, especially if they can earn better pay in the private sector or a less stressful setting.

This vicious cycle leaves prisons perpetually understaffed medically. The shortage of mental health professionals is equally acute – many systems have only a handful of psychologists to cover thousands of inmates. Some states have turned to telemedicine to mitigate this, but virtual care has its limits, especially for seriously mentally ill patients who need intensive, in-person interventions. Dental staff are also scarce (as noted earlier), with some prisons only having a dentist on site a few days a month. In extreme cases, facilities might have no full-time physician at all – relying on nurse practitioners or physician assistants, or visits from off-site doctors periodically. This means chronic conditions aren’t managed with consistent oversight, and when emergencies strike, on-site expertise may be lacking.

For the prison staff who are present, the workload can be crushing. One prison nurse might be responsible for hundreds of patients. Correctional officers, too, face immense pressure when medical staffing is thin – they often must make judgment calls about when an inmate’s complaints are serious enough to call in scarce medical help, and they may end up performing first aid or suicide watch duties outside their training. In sum, understaffing is the thread that runs through the fabric of prison healthcare problems. It contributes to long wait times, rushed or substandard treatment, and a higher likelihood of mistakes. Efforts are underway in some places to boost salaries and recruitment for these hard-to-fill roles; for instance, states like Tennessee and Texas raised starting pay for correctional officers significantly in hopes of attracting more applicants. But as officials acknowledge, hiring is only half the battle – retention is the real hurdle when the working conditions involve mandatory overtime, high stress, and, oftentimes, inadequate resources to do the job properly. Until the staffing gap is addressed, meaningful improvement in inmate healthcare will be difficult to achieve.

Delays in Treatment and “Care” by Crisis

One of the most tangible symptoms of the strains on prison healthcare is the prevalence of delays – delays in seeing a doctor, delays in receiving medications or diagnostic tests, delays in getting sent to a hospital or specialist. These delays can transform what would be routine health issues into severe, even life-threatening conditions. In many documented cases, incarcerated patients have waited months or years for necessary treatment, far beyond any acceptable community standard of care. For example, at the Arizona women’s prison in Perryville, a woman diagnosed with brain cancer in 2022 had surgery to remove part of a tumor – but then languished 15 months without the follow-up radiation therapy she desperately needed. She repeatedly asked for oncological care, but radiation did not begin until July 2023. Another woman at the same prison, suffering from a spinal condition that risked paralyzing her, was told she urgently needed surgery – yet months later, she still did not even have a scheduled appointment for it. “I have to have this surgery or I’m going to be paralyzed… [but] I don’t know when my next appointment will be,” she said in early 2025. She added that many other women there also needed surgeries or specialized care that they were not getting. Such stories are unfortunately common across many prison systems.

Court findings from oversight of prison healthcare further illustrate how dangerous these treatment backlogs can be. In the Arizona case mentioned, experts reviewing numerous inmate death records found that “horrible care” – including extreme delays in treatment – led to “unnecessary suffering and lost opportunities for treatment and cure”, ultimately causing deaths that might have been prevented. In other words, prisoners died from illnesses like cancer, heart disease, or complications of chronic conditions not solely because those diseases are untreatable, but because the care they received was too little, too late. The use of stopgap measures like telehealth in inappropriate situations has also drawn criticism; for instance, attempting to manage complex or emergent conditions via telemedicine (due to lack of on-site doctors or unwillingness to transport inmates) can delay hands-on intervention and worsen outcomes.

Delays in specialty care are a particular problem. Even when a prison doctor recognizes that a patient needs to see, say, a cardiologist or neurologist, arranging that consult may be an uphill battle. Security transport, scheduling with outside providers, and costs all pose hurdles. Prisons like Arizona’s had performance benchmarks (from legal settlements) requiring that patients referred to a specialist actually see that specialist within 30 days. Yet compliance was chronically poor – many referrals simply “fell through the cracks,” never fulfilled in time. Whether it’s getting an MRI scan, starting physical therapy after an injury, or consulting a surgeon, inmates often find themselves in a holding pattern for far longer than any free-world patient would tolerate. In the interim, they remain in pain or their condition deteriorates. This “care by crisis” approach means that only when someone’s health utterly breaks down do they get rushed out for emergency care, whereas earlier intervention could have mitigated the crisis entirely.

These treatment delays are frustrating and demoralizing for incarcerated individuals – and they also create ripple effects that impact prison management and staff. Prisoners who feel their medical needs are ignored may become agitated or hopeless, which can manifest in behavioral issues, rule infractions, or frequent complaints/grievances that staff must deal with. Correctional officers often find themselves on the front line of these frustrations. In extreme cases, neglect of health can trigger unrest. (There have been instances in the past where inmates staged protests or filed mass grievances over deficient medical care.) Even when that’s not the case, a prisoner whose condition worsens due to delayed care might eventually require urgent hospitalization – which then suddenly consumes significant staff resources to transport and guard the inmate at an outside hospital, usually at odd hours. It is an expensive, reactive cycle. As one prison advocacy group leader put it, “the lives and well-being of both staff and incarcerated people are on the line. We’re all in the same toxic environment.” Allowing treatable conditions to escalate not only harms inmates but also means more crises for staff to manage.

In summary, delayed and haphazard treatment is a hallmark of the current prison healthcare landscape. Many incarcerated people do not receive timely care for serious medical needs, leading to needless suffering and higher downstream costs (in human and financial terms). It is a scenario that puts prison systems at risk of legal liability as well – federal courts have not hesitated to find Eighth Amendment violations when pervasive delays amount to deliberate indifference to inmates’ medical needs. The persistence of such delays signals a system stretched beyond its capacity, where reactive emergency care often substitutes for proactive, preventive medicine.

Impact on Prison Operations and Staff

The healthcare problems in prisons don’t only affect inmates – they also create major challenges for day-to-day operations and the well-being of correctional staff. When inmate health needs go unmet, the fallout often lands on the shoulders of officers, administrators, and healthcare workers trying to keep facilities safe and orderly. In recent years, prisons have been caught in a dangerous feedback loop: overcrowding and understaffing lead to reduced services and harsher conditions, which in turn lead to more illness, stress, and instability inside, further straining the remaining staff. This dynamic has become increasingly evident from 2020 onward, as many prisons face staffing crises while dealing with an aging, high-needs population.

One stark response to understaffing has been the resort to frequent or prolonged lockdowns. In a fully staffed prison, inmates would regularly go to medical appointments, recreation, classes, etc. But in facilities with severe personnel shortages, wardens sometimes impose “modified movement” or lockdowns to reduce the demands on staff. This means keeping prisoners in their cells for most of the day and sharply limiting activities – a practice which, while maintaining basic security, also disrupts healthcare access and exacerbates tensions. A recent investigation found that at least 33 state prison systems used non-disciplinary lockdowns repeatedly between 2016 and 2023 due to staffing or safety issues. Illinois is a prime example: by late 2024, more than two dozen Illinois prisons had seen staff protests over unsafe conditions, and at least four facilities were under partial or full lockdown as a result. In Illinois, the number of lockdown incidents skyrocketed from 635 in FY 2019 to 1,814 in FY 2024 – nearly triple – reflecting how routine this emergency measure has become. While lockdowns might temporarily ease the burden on an overstretched staff, they have dire side effects. Inmates on lockdown often miss clinic appointments or pill call, skip showers (affecting hygiene), and experience rising anxiety and anger from being confined 24/7. Michele Deitch, a prison policy expert, noted that these lockdowns are essentially using solitary-confinement-level restrictions as a stopgap for staffing woes, and warned that “you’re going to see a lot more tension… which could lead to more assaults and other kinds of abuses” in such conditions.

Indeed, facilities with chronic understaffing and poor healthcare have reported higher rates of violence and incidents. In Iowa’s state penitentiary, for example, a serious assault on two staff members in 2023 was the 33rd attack that year at that prison – a spike that union leaders explicitly linked to the facility being severely short-staffed and over-stressed. In Georgia, a U.S. Department of Justice investigation in 2022 found “rampant” violence and abuse in the state’s prisons, conditions the DOJ said violated inmates’ constitutional rights, with understaffing identified as a key factor. It is not a coincidence that when officers are spread thin (or medical needs unmet), contraband, gang activity, and conflicts behind bars become harder to control. Staff themselves are endangered in such environments. As noted, assaults on guards have risen in some states; in Illinois, officers cited being exposed to more inmate attacks and even toxic drug fumes due to lack of adequate personnel to maintain order. This creates a vicious cycle: dangerous conditions drive more staff to quit, which further worsens the safety and service gaps for those who remain.

For correctional staff, the toll of this crisis is both physical and mental. Officers and prison nurses are frequently required to work mandatory overtime to cover shifts, leading to exhaustion and burnout. In North Carolina, for example, the Department of Correction spent over $67 million on overtime pay in FY 2023-24, which was more than 11 times what had been budgeted. Many officers are pulling 16-hour shifts regularly. As one prison official bluntly told lawmakers, such extreme overtime “puts facilities at risk and takes a toll on staff”, with overwork and low pay being top reasons staff leave the job. Nationwide, advocacy groups representing correctional employees have raised alarms that staff are “running on empty”. One group founder noted that these grueling schedules leave officers with little time to rest or see their families, eroding morale and health. Stress-related ailments among correctional staff – from anxiety and depression to hypertension – are reportedly on the rise, making prison staff some of the unhealthiest workers in law enforcement overall.

Operationally, prisons have had to take drastic steps to cope. Some have closed entire housing units or reduced inmate capacity because they simply don’t have enough staff to safely supervise all the beds. (This happened in North Carolina, as well as states like West Virginia and Texas in recent years.) Other states have brought in National Guard members on a temporary basis to staff prisons during acute shortages – an extraordinary measure that underscores how dire the situation is. The use of private agencies to supply temporary nurses or guards is another expensive band-aid. And as mentioned, lockdowns and curtailing programs are short-term fixes that create long-term problems.

For prison administrators, these healthcare and staffing problems also mean increased legal exposure and oversight. Numerous states – California, Arizona, Illinois, Alabama, to name a few – have been hit with class-action lawsuits over inadequate inmate medical or mental health care. Courts have at times appointed outside receivers or monitors to take over prison health systems (California’s prison healthcare was under federal receivership since 2005, and advocates are currently pushing for a receiver in Arizona). These interventions, while aimed at protecting inmates’ rights, often come after years of state inaction and can be politically contentious. But failing to improve conditions can result in costly contempt fines (Arizona was fined $1.4 million in 2018 for noncompliance with a healthcare settlement) and, worse, continued loss of life.

In summary, the operational repercussions of poor inmate healthcare reverberate through the entire institution. Safety and security are undermined when prisoners’ basic health needs are neglected. Staff are asked to compensate for systemic deficiencies by working harder and longer, in tougher conditions, which many understandably find unsustainable. The high turnover and vacancy rates then perpetuate the cycle of limited services and reactive crisis management. As prison populations have begun to tick upward again post-pandemic (state prison populations grew about 2% from 2021 to 2022), the strain on facilities and staff could worsen if reforms are not implemented. The challenges of inmate healthcare are thus not isolated to the medical unit – they are truly system-wide challenges that affect security, budgets, staff retention, and the overall mission of corrections.

Conclusion

From coast to coast, the picture of inmate healthcare in 2023–2025 is one of a system in crisis. Prisons and jails are housing some of the nation’s most vulnerable individuals – people with high rates of illness, addiction, and mental health disorders – yet these institutions are ill-prepared and under-resourced to meet the demand for care. The national trends are alarming: an aging inmate population with multiple chronic diseases; rampant mental health needs going untreated; dental problems addressed only in emergencies; essential medications and treatments delayed or denied; and a chronic shortage of qualified healthcare staff to deliver care. The result is that incarcerated persons frequently suffer needlessly, and in some cases die prematurely from preventable causes due to neglect or delayed intervention. For those working in U.S. prisons, these healthcare failures create a more dangerous and difficult work environment – one marked by constant emergency responses, overwork, and moral distress at not being able to help people in dire need.

It is often said that the true measure of a society is how it treats those it has confined. By that measure, the current state of inmate healthcare raises serious concerns. There are, however, glimmers of progress: growing awareness of the issues has prompted reforms in some jurisdictions (such as expanding addiction treatment programs or increasing budgets for prison health services). The federal government’s recent efforts to enable Medicaid coverage just prior to release and other reentry health initiatives are also hopeful signs. But much more remains to be done inside the walls. Ensuring adequate inmate healthcare is not just a legal obligation to avoid cruel and unusual punishment – it is also pragmatic policy for public health and safety. Prisons that provide timely, effective care will have healthier populations, which in turn means fewer crises, less strain on staff, and inmates better prepared to reenter society as productive citizens. By contrast, failing to address these healthcare challenges simply guarantees higher costs (through litigation, emergency hospitalizations, and recidivism due to untreated issues) and continued human suffering.

For the professionals working on the front lines in prisons, understanding these national trends can help contextualize the day-to-day frustrations they witness. They are not alone – correctional nurses in one state, mental health counselors in another, and officers in yet another are all facing similar obstacles born of systemic shortcomings. The hope is that by shining a light on the realities of inmate healthcare in America, stakeholders and policymakers will be moved to act – to allocate resources, update policies, and innovate solutions that benefit both incarcerated people and the staff dedicated to their care. In the end, improving healthcare in prisons is a win-win goal: it upholds the dignity and rights of those in custody and creates a safer, more manageable environment for those who work there. The challenges are steep, but the cost of inaction – measured in lives and livelihoods – is far steeper.

Sources: The information in this article is drawn from a range of recent reports, studies, and news investigations on U.S. correctional healthcare. Key references include data from the Bureau of Justice Statistics, analysis by the Prison Policy Initiative, expert commentary in medical journals, and on-the-ground reporting from 2023–2025. Notable examples and statistics were cited from these sources throughout the text, among others, to provide a factual and up-to-date picture of the state of inmate healthcare nationwide. Each citation corresponds to a specific supporting document or study, available for further review.